A New Approach to Solving Health Disparities

Social factors such as access to transportation and the availability of pharmacies can have a profound impact on a community’s overall health and the cost of caring for its residents when they become ill.

The newly formed Blue Cross Blue Shield Institute, a subsidiary of the Blue Cross Blue Shield Association, is taking aim at these factors — known as the social determinants of health — by analyzing health insurance claims data at the local level, then tailoring insurance programs as well as partnerships with other businesses to meet that specific community’s most pressing issues. The institute’s initial partnerships are with ride-hailing company Lyft, CVS Health and Walgreens to address transportation and pharmacy shortages.

“About three years ago, we recognized that to improve population health, we had to go outside the traditional four walls of the hospital and physician’s office,” says Dr. Trent Haywood, president of the institute and chief medical officer for the Blue Cross Blue Shield Association, a federation of 36 independent Blue Cross and Blue Shield companies. “That set us on a journey to approach the social determinants of health with a sustainable business model behind it.”

The National Academies of Science, Engineering and Medicine identified nine factors as the social determinants of health: income and wealth, housing, health systems and services, employment, education, transportation, social environment, public safety and physical environment. Deficiencies in these areas may lead to poor health and more expensive care because patients tend to be much sicker when they finally seek treatment. Haywood estimates about 60 percent of health outcomes are driven by these social factors.

Dr. Derek Robinson, vice president of quality and accreditation for the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, explains the promise of the partnership with the Blue Cross Blue Shield Institute.

Using the vast, de-identified pool of data from Blue Cross and Blue Shield members, the association developed a digital hub that maps the entire country, down to the ZIP code level, with data on the social determinants of health in each community. It provides a snapshot of the social issues in an area, such as lack of access to pharmacies, grocery stores or green spaces for outdoor activity. The data can then be used to develop products and solutions for members in that particular area.

“We think the Blues Plans are in a unique position to address the social determinants of health,” Haywood says. “We have the depth and reach to be in every ZIP code where people live, and the relationships to leverage at those local levels.”

The partnership with Lyft is scheduled to launch as a pilot this year with select commercially insured members in Chicago, Pittsburgh, Oklahoma City and Tulsa, Oklahoma. Under the program, Blue Cross and Blue Shield Plans will pay for rides to primary care appointments for patients in those communities where lack of transportation is a barrier to health – sometimes called “transportation deserts.”

We have the depth and reach to be in every ZIP code where people live.

The institute estimates 3.6 million Americans miss or delay medical appointments because of transportation barriers. Haywood says the institute will be able to use the Lyft data within its community management hub to determine if having access to rides makes a measurable difference in the health of a certain community.

“From the start, we said the Lyft pilot had to be looked at from the perspective of improving health outcomes, not just from how many people get rides,” Haywood says. “That required us to have the infrastructure to look at it at the granular level — things like hospital visits and medication.”

In addition to rides to and from appointments, the institute also is piloting ride-hailing programs to get patients to the pharmacy for their medications. Select Walgreens locations in Chicago and some CVS stores in Pittsburgh are paying for rides to and from their locations for some commercially insured Blue Cross and Blue Shield members. The goal is to improve medication adherence rates and, in turn, improve the health of the patients prescribed those medications. Studies have shown that 20 percent to 30 percent of medication prescriptions are never filled, and about half of medications for chronic diseases are not taken as prescribed.

“We continue to hear from the (Blues) Plans that if we want to have successful population health outcomes, we need to address adherence to medications,” Haywood says. “Walgreens and CVS came forward to pilot that portion with us, making certain there is easy access to the retail pharmacy for patients.”

The institute plans to add programs in 2019 that address nutrition and fitness disparities. Haywood says the time is right for these programs because care is rapidly shifting to a value-based model, with the primary goal to keep patients healthy and out of the hospital. In addition, technology is making it simpler to create programs that provide assistance like ride-hailing or online grocery ordering.

“It’s amazing now the things we can do,” he says. “Success for us will be a viable marketplace that’s sustainable and achieving our goals on the social determinants of health.”

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